In the 25 years that I have been teaching in New York, graduate medical education has changed a great deal. Clearly, much has improved. However, the recent restrictions in work hours are an ominous development because of their effect on both patient care and the education of our future physicians (Table). Organizations that do not thoroughly understand the nature of graduate medical education are promulgating these restrictions. The forces cannot be dismissed; they include our governing bodies (1), state and federal government (2), and the public (3).

The restriction of work hours was codified in New York with the unfortunate death of a young woman, Libby Zion, the daughter of a well-known journalist. At the time of her death, work hours had already been reduced substantially. My mentors had described living in the hospital with only an occasional weekend off. By the time I began my residency, the call schedule was every third night. These changes, which evolved over the decades, were not mandated by outside agencies.